ABSTRACT
Background: Older adults with pre-existing health conditions such as cancer are at higher risks of COVID-related morbidity and mortality. Moreover, the pandemic has triggered new sources of anxiety and stress impairing their quality of life (QoL), such as fear of infection, financial challenges, and social isolation. The goal of this study is to evaluate the changes in QoL of breast cancer patients and survivors during the pandemic and assess whether racial/ethnic minority patients were disproportionately affected. As the COVID-19 vaccines become available, another goal of the study is to examine the vaccination rate and symptoms after vaccination among patients of different racial/ethnic groups. Method(s): Two waves of surveys were sent out to the breast cancer patients registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort (ChiMEC) via RedCap in the summers of 2020 and 2021 with response rates of > 48%. To measure anxiety and stress, we calculated an overall score (ranging from 0-44) using 11 questions on a 5-point Likert scale, with lower score representing better QoL. The questions were adopted from existing item banks, and the items showed good internal consistency (Cronbach's alpha = 0.84). The second survey also contained questions on vaccination status, concerns, and symptoms after vaccination. Result(s): In the first wave of survey in 2020, no significant racial differences were found in the anxiety/stress scores among the 1300 breast cancer patients. In the second wave of survey in 2021, 1348 patients responded, with 66% of them also respondents of the previous survey. Compared to 2020, the average anxiety/stress score in 2021 decreased from 13.2 to 12.2 for White patients, while increased from 12.8 to 13.6 for Black patients. Mixed effects models showed that the scores worsened significantly for Black patients while improved significantly for White patients. Compared to Whites, Black patients were significantly less confident to find medical help and keep up with work/home responsibilities, while significantly more likely to feel isolated and overwhelmed, and more frequently worried about being sick and going to hospitals. The racial differences in the anxiety/stress scores became insignificant after adjusting for annual household income in multivariate linear mixed effect models. In terms of Covid-19 vaccination, 92.2% of the respondents got vaccinated, with no significant racial/ethnic difference. However, there were more Black patients who had not decided yet or did not respond to this question (Table). The major concerns for patients were the long-term and short-term side effects of the vaccines. In terms of symptoms after vaccination, the most reported symptoms were pain at injection site (62.0%), tiredness (50.2%) and muscle or body aches (30.8%). Conclusion(s): Through a longitudinal study, we found that although the anxiety/stress scores of our patients remained moderate, White patients were having improved QoL while Black patients were doing worse. A third wave of survey is planned in the summer of 2022 to further examine this trend. In our study, the vaccination rates were very high among all racial/ethnic groups and the symptoms after vaccination were similar to the ones demonstrated in the general population. We hope that this information can proactively address some patients' concerns about getting vaccinated.
ABSTRACT
Background: As the number of patients with a cancer diagnosis grows in the United States, there is an increasing need for physician scientists with oncology-related research training to develop new approaches to screening, diagnosis, therapy, and survivorship. A single US medical school developed the National Cancer Institute-funded Scholars in Oncology-Associated Research (SOAR) cancer research education program. Due to the COVID-19 pandemic, SOAR transitioned from fully in-person in 2019 to virtual in 2020 and hybrid in 2021. This study examines whether the in-person, virtual, or hybrid formats provide better educational experiences as rated by participants. Methods: SOAR includes a seminar series, an 11-week full-time cancer research experience, weekly research cluster group meetings, and tumor board and interprofessional shadowing experiences. In 2019 all program activities were in-person. In 2020 all activities were virtual with the shadowing suspended. In 2021, seminars and tumor boards were virtual, shadowing was in-person, and all other activities were hybrid. Pre- and post-surveys were collected from all participants to assess understanding of oncology and associated medical specialties. How participant understanding of oncology and related specialties changed within each year's program was analyzed with a Wilcoxon rank-sum test. The Kruskal-Wallis test was used to examine change in understanding between the cohorts. Results: 37 students participated in SOAR (2019 n = 11, 2020 n = 14, 2021 n = 12). Self-reported understanding of oncology as a clinical (p < 0.01 for all) and research discipline (p < 0.01 for all) improved within all three cohorts. There was no significant difference between each cohort's improvement in research understanding (p = 0.6158). However, there was a trend towards more of an improvement in the in-person cohort (p = 0.0796) for clinical understanding. There was no significant difference between each cohort's improvement in understanding of oncology-related disciplines such as medical oncology, radiation oncology, pediatric oncology, surgical oncology, and survivorship as both clinical and research disciplines (p > 0.1 for all). Conclusions: A virtual cancer research education program can be as effective as an in-person or hybrid program for research education although it may be suboptimal for learning about clinical oncology. Given the ongoing challenges presented by the COVID-19 pandemic, flexibility is needed in delivering cancer research education programs such as SOAR. With modern research methodology and communications technology, cancer research is becoming increasingly diverse and flexible in terms of research environment. If program leaders are steadfast in their adaptation of research education programs to a virtual or hybrid environment, participant understanding of oncology as a clinical and research discipline remains robust.